Association Between Fire-Related Particulate Matter Exposure and Childhood Asthma in Peru: A Burden of Disease Assessment

We explore the connection between exposure to particulate matter from forest fire emissions in the Peruvian Amazon and pediatric asthma incidence. The bulk of research and media coverage surrounding the Amazon Rainforest fires has focused on important environmental issues, yet the direct impact that these fires have on the health of children living nearby remains underexplored. We conducted a burden of disease assessment using publicly available data to estimate the number of incident pediatric asthma cases attributable to long term exposure to ambient particulate matter smaller than 2.5 microns (PM2.5) resulting from increased forest fires in the Peruvian Amazon. Our model compares pediatric asthma burden that would have resulted from a more “typical'' fire year, such as 2009, with that from 2016, a severe fire year, by applying PM2.5 concentrations from each of those years to the same 2016 population. We estimate that 75,160 (95 % CI 28,638, 121,682) pediatric asthma cases in 2016 were attributable to PM2.5, whereas counterfactually applying the 2009 PM2.5 concentrations would have resulted in 9,636 (95 % CI 5,657, 13,615) fewer attributable cases. Thus, our results suggest that increased forest fire emissions have led to a notable increase in pediatric asthma burden in Peru

Effectiveness of bilateral tubotubal anastomosis in a large outpatient population

Is bilateral tubotubal anastomosis a successful treatment in an outpatient patient population

Using DHS to Identify Sites for HIV Prevention Trials

Recruiting high-risk, HIV-negative participants is challenging for HIV prevention trials. This study aimed to 1) identify and characterize subsets of high-risk women based on responses to demographic and psychosocial questions from the AIDS Indicator Survey (AIS) and 2) develop a rapid, inexpensive tool for site identification. We developed a latent class model (LCM), hypothesizing that AIS respondents could be grouped by responses to psychosocial indicators, and that these latent classes would vary by HIV status, socio-demographic, and other indicators. We tested our model on women respondents from the Tanzania 2003 AIS Survey, and replicated it in several other populations.  LCM produced four classes of women who significantly varied by psychosocial indicators and HIV status. Geographic differences in HIV prevalence and class composition were observed. Our approach has the potential to provide a more systematic, inexpensive and rapid strategy to identify HIV prevention trial sites

First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.

BACKGROUND: The dose of mifepristone approved by most government agencies for medical abortion is 600 mg. Our aim was to summarize extant data on the effectiveness and safety of regimens using the widely recommended lower mifepristone dose, 200 mg, followed by misoprostol in early pregnancy and to explore potential correlates of abortion failure. STUDY DESIGN: To identify eligible reports, we searched Medline, reviewed reference lists of published reports, and contacted experts to identify all prospective trials of any design of medical abortion using 200 mg mifepristone followed by misoprostol in women with viable pregnancies up to 63 days' gestation. Two authors independently extracted data from each study. We used logistic regression models to explore associations between 15 characteristics of the trial groups and, separately, the rates of medical abortion failure and of ongoing pregnancy. RESULTS: We identified 87 trials that collectively included 120 groups of women treated with a regimen of interest. Of the 47,283 treated subjects in these groups, abortion outcome data were reported for 45,528 (96%). Treatment failure occurred in 2,192 (4.8%) of these evaluable subjects. Ongoing pregnancy was reported in 1.1% (499/45,150) of the evaluable subjects in the 117 trial groups reporting this outcome. The risk of medical abortion failure was higher among trial groups in which at least 25% of subjects had gestational age >8 weeks, the specified interval between mifepristone and misoprostol was less than 24 h, the total misoprostol dose was 400 mcg (rather than higher), or the misoprostol was administered by the oral route (rather than by vaginal, buccal, or sublingual routes). Across all trials, 119 evaluable subjects (0.3%) were hospitalized, and 45 (0.1%) received blood transfusions. CONCLUSIONS: Early medical abortion with mifepristone 200 mg followed by misoprostol is highly effective and safe

Quality improvement teams, super-users, and nurse champions: a recipe for meaningful use?

Objective This study assessed whether having an electronic health record (EHR) super-user, nurse champion for meaningful use (MU), and quality improvement (QI) team leading MU implementation is positively associated with MU Stage 1 demonstration

Plato on Well-Being

Plato's dialogues use several terms for the concept of well-being, which concept plays a central ethical role as the ultimate goal for action and a central political role as the proper aim for states. But the dialogues also reveal sharp debate about what human well-being is. I argue that they endorse a Socratic conception of well-being as virtuous activity, by considering and rejecting several alternatives, including an ordinary conception that lists a variety of goods, a Protagorean conception that identifies one's well-being with what appears one to be one's well-being, and hedonistic conceptions

Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhoea

Colonic infection with Clostridium difficile, leading to pseudomembranous colitis, is a common complication of antibiotic therapy, especially in elderly patients. It has been suggested that non-pathogenic probiotic bacteria might prevent the development and recurrence of C. difficile infection. This double-blind, placebo-controlled study examines the role of probiotic administration in the prevention of C. difficile-associated diarrhoea (CDAD) in elderly patients receiving antibiotic therapy. Consecutive patients (150) receiving antibiotic therapy were randomised to receive either a probiotic containing both Lactobacillus and Bifidobacterium or placebo for 20 days. Upon admission to hospital, bowel habit was recorded and a faecal sample taken. Trial probiotic or placebo was taken within 72 h of prescription of antibiotics, and a second stool sample was taken in the event of development of diarrhoea during hospitalisation or after discharge. Of the randomised patients, 138 completed the study, 69 with probiotics in conjunction with antibiotics and 69 with antibiotics alone. On the basis of development of diarrhoea, the incidence of samples positive for C. difficile-associated toxins was 2.9% in the probiotic group compared with 7.25% in the placebo-control group. When samples from all patients were tested (rather than just those developing diarrhoea) 46% of probiotic patients were toxin-positive compared with 78% of the placebo group. [Int Microbiol 2004; 7(1):59–62

Centrosome amplification induces high grade features and is prognostic of worse outcomes in breast cancer

Table S1. Patient characteristics. Table S2. Hazard ratios from multivariate analysis. Table S3. Sequences of primers used for qRT-PCR. Figure S1. Distribution of average centrosome number per cell in the breast cancer patients represented in our TMA. Figure S2. Correlations between centrosome amplification and nodal status, patient age, and tumor size. Figure S3. Centrosome clustering but not structural abnormalities correlate with worse outcomes in breast cancer. Figure S4. CIN is prognostic of worse breast cancer-related survival. Figure S5. Centrosome amplification correlates with adverse clinical factors. Figure S6. CA correlates with higher ploidy and CIN. (DOCX 6223 kb

Imaging calcium microdomains within entire astrocyte territories and endfeet with GCaMPs expressed using adeno-associated viruses.

Intracellular Ca(2+) transients are considered a primary signal by which astrocytes interact with neurons and blood vessels. With existing commonly used methods, Ca(2+) has been studied only within astrocyte somata and thick branches, leaving the distal fine branchlets and endfeet that are most proximate to neuronal synapses and blood vessels largely unexplored. Here, using cytosolic and membrane-tethered forms of genetically encoded Ca(2+) indicators (GECIs; cyto-GCaMP3 and Lck-GCaMP3), we report well-characterized approaches that overcome these limitations. We used in vivo microinjections of adeno-associated viruses to express GECIs in astrocytes and studied Ca(2+) signals in acute hippocampal slices in vitro from adult mice (aged ∼P80) two weeks after infection. Our data reveal a sparkling panorama of unexpectedly numerous, frequent, equivalently scaled, and highly localized Ca(2+) microdomains within entire astrocyte territories in situ within acute hippocampal slices, consistent with the distribution of perisynaptic branchlets described using electron microscopy. Signals from endfeet were revealed with particular clarity. The tools and experimental approaches we describe in detail allow for the systematic study of Ca(2+) signals within entire astrocytes, including within fine perisynaptic branchlets and vessel-associated endfeet, permitting rigorous evaluation of how astrocytes contribute to brain function

Are children with asthma overconfident that they are using their inhalers correctly?

The objectives of this study were to quantify the extent to which children with asthma are overconfident that they are using their inhalers correctly and determine whether demographic and clinical characteristics are associated with children being overconfident